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This is a personal web site, reflecting the opinions of its author. It is not a production of my employer, and it is unaffiliated with ANY hospital, medical center, medical practice or other physicians. Statements on this site do not represent the views or policies of anyone other than myself. The information on this site is provided for discussion purposes only, and are not medical recommendations. I offer no guarentee as to the accuracy of anything stated and the information here is at times, highly speculative and does not constitute advice to/not to diagnose or treat. Any personal medical issues the reader may have should be referred immediately to the reader's private physician and under no circumstances should anyone delay, change, or alter any medical treatment or planned treatment or diagnosis based on anything read on this site. Under no circumstances does any herein contained information represent a medical recommendation.

DID TEDY BRUSCHI HAVE A STROKE?__________________________________________________

1. A stroke is defined by damage to the brain. If there is no damage, there is no stroke.

2. There has been NO objective evidence mentioned or described in the Tedy Bruschi case to indicate a stroke has occurred -- although every single press report and Internet post states unequivocally that Bruschi had a stroke

3. Just evaluating the relatively abrupt onset and resolution of symptoms, the best guess is that he either had a migraine with stroke-like features; or, a TIA ( = same symptoms as stroke but without brain damage), for unknown reason

4. If Bruschi really did have a stroke there would be unequivocal evidence seen on the diffusion weighted MRI (always done in these cases); yet, no one mentions a positive MRI or CT scan

5. If Bruschi DID have a stroke then, listed roughly in the order of likeliness, Bruschi suffered from :

6. Some reports (leaked from the Patriot organization, according to The Boston Globe) implicate a "broken blood vessel." This would implicate bleeding into a small vascular malformation; or, an injury to the carotid artery.

7. The reason we have these questions and doubts is because those reporting on the situation are either uninformed, uninterested, unmotivated to learn, or covering up something.

8. Newspaper and Internet journalists daily propagate medical myths, misunderstandings, and falsehoods because of -- one can only assume -- lassitude, hubris, or ignorance. This behavior contributes to the MEDICAL INFANTALISM we see in the American health care consumer

9. Because of the above, journalists bears some of the blame for the current "health care crisis;" and, by logical extension they have the power to participate in the remediation of the crisis

Comments

I've heard the "broken blood vessel" thing in several reports, but I suspect those were all copycats, and as for MRI/CT results, and regading the FIRST #4 above,they did say they were doing a number of tests on Thurs. and Fri. Frankly, if I were the Bruschi family, I wouldn't want the nature of my tests or their results released to the general public.

If they had positive DT-MRI results would you feel less like it was a coverup?

There are two different "blood vessels" mentioned in news reports. One of these items specifically refers to a blood vessel in the brain. The other item refers to a dissection and implicates the carotid artery. I'll post on this later.

The issue here, for me, has almost nothing to do with Teddy Bruschi. The primary issue is the total inadequacy of the news reporting. The way the reporters use the word "stroke" indicates that they don't understand the implication or meaning of that word. I cannot overstate the importance of this public deficit. I intend to address this later.

But the inadedquacy of the reporting has a second deleterious effect as I am trying to put a point on: it leaves Teddy Bruschi's reputation is vulnerable to speculation -- something that I believe his family should be MUCH more concerned about. Truth is, one of the most COMMON reasons for someone in his age bracket to have a stroke is chemical vasculitis from cocaine use. Without accurate reporting, Bruschi is vulnerable to this suspicion.

Finally...do I really think that there is a "coverup?" I won't say. That is not my burden. I look at what is reported and draw conclusions. It is the burden of the reporters NOT to leave themselves or the hospital or Teddy Bruschi and his reputation open to this speculation.

Both of your points are valid. I 100% agree with you on the reporting issue. Since the reporters are ignorant, they're just parroting the MDs. But by the same token, I think bad reporting will leave the cocaine implications uncovered. I think it's probably too sophisticated a connection for most reporters. If Bruschi had suffered a heart attack rather than a "stroke", I suspect we'd have heard all kinds of drug use speculation by now, since cocaine use and heart malfunction go together in the general psyche (Len Bias, etc.)

You validated what I do and the theoretical structure I have created that makes me believe the methodology might work. Thank you.

After I contemplate the hundreds of hours I spend reading, writing, and blogging related to this site (When I Consider How My Light Is Spent) -- with no remuneration, and frequently with painfully few readers...after I delete the hate mail and death threats and spam...I sometimes resort to prolonged omphaloskepsis to contemplate how I ought to spend my time, and towards what ends.

The overarching rationale for what I do is the power and potential of this medium. You are right. If we left it to the news reporters -- those worn out gate keepers who have kept us shackled in the dungeons of their reporting since the first paper was printed -- no one WOULD ever connect Tedy Bruschi's stroke with cocaine use. But I connected it. And if I hadn't, some one else would have.

Not to say that this is the case (cocaine induced vasculitis and stroke), but it is paradigmatic, because if millions of people are participating in the real-time evolution of the news, then no one can hide from the truth. Not Dan Rather, not Viktor Yushchenko, not Tedy Bruschi.

It is MY thesis that Americans are health care idiots. But, in this case it is nurture, NOT nature. American health care consumers are abused children, initially beaten into submission by smart, overweening physicians with skills limited by science and who -- in the past -- shamefully circumvented their empirical shortcomings with domineering hubris. Now, in the current era, these consumer fledglings are being malnourished by a reimbursement system that discourages their education, does not afford them the opportunity to feedback their outcomes and opinions on providers; and, ultimately infantalizes them with the inevitable goal of nationalizing health care thus completing the transition from idiot to moron.

This medium has the potential to educate, correct, and stimulate. The immediate, widespread availability of the infoprmation allows for massive assimilation and feedback. If someone strikes a flint in the dry timber, there could be a fire.

News reporters need to know that we are watching their words, and dissecting their reports. No more free rides. You said Tedy Bruschi had a stroke?

Let me tell you that this is not really IN THE PAST.
There are many physicians who have shortcomings (not necessarily due to lack of empiricism), but rather overt incompetence, who continue to practice.
I am a very sophisticated medical consumer given my training and background. I went to a neurologist with multiple neurologic symptoms. Since he could not use Occam's Razor and come up with one explanation for my symptoms he used the female cop out wastebasket diagnosis and suggested that I had fibromyalgia!
I have since seen different physicians and had demyelinating axonal damage documented on bilat LEs (have B-12 deficiency), and have had a c-spine epidural injection that resulted in alleviation of my R sided pain symptoms - essentially demonstrating that despite the MRI stating there was mild contour deformity, but no compression on c-spine MRI, I do in fact have cervical myelopathy. So, were I not as sophisticated a consumer as I am, I would be thinking that I had fibromyalgia and be risking further neurologic damage rather than seeking neurosurgical evaluation.

Many physicians (and NPs as well) hate the patient who has tried to educate themselves and comes in with internet information printed out. Because then the provider must spend time actually TALKING to the patient and explaining things. One thing we can do as healthcare professionals is direct patients to reputable internet sites that provide accurate information.

That's an amazing diagnosis. I'm sure that you have looked into the possible causes...are you a long-term user of H2 blockers? isw it an elaboration or absorption issue?

As for your comment...

There will always be "bad" doctors (for all the same reasons people fall short in any profession) however, I was referring to a time when there were few therapeutic options to offer, so physicians, in my opinion, frequently compensated by their carriage, aloofness, and paternalism.

In defense of today's physician, our societal cult/game of liability lotteries has combined with decreasing reimbursement to result in the same product degredation you would see in any other field or profession.

One answer is to become well-informed and an intelligent consumer. But that is not the only answer. We absolutely need to move the entire system towards a more free-market approach and work hard to defeat the ever-present urge to nationalize the profession.

Dr.Code Blue, I agree with you. Why didn't the Press just blame "allergies"? They seem to cover everything vacuously enough.

And why the study of physiology and disease is not mandatory in schools of primary education is a mystery, indicating some kind of massive fear and denial of some most important realities.

Any M.D. who does not pursue diagnoses as a mission should not have the title. But this lack is what Socialists and other non-entities [such as the p.c.] desire, as you indicate. There will be more to "manage" that way.

Then we have the Bialy, Esmay, Duesberg axis in denial that the hiv causes aids. That always helps.

The B-12 deficiency is due to pernicious anemia - an autoimmune disorder that causes me to have antibodies to intrinsic factor. The pernicious anemia, coupled with my previously diagnosed hypothyroidism gives me the wonderful benefit of being able to say I have polyglandular autoimmune syndrome. Think it is PAS - 2 or 3. NEJM had an article about it a few months back.
Amazingly, when I mentioned my diagnosis to one of our fellows at work he said, "wow, they always tell us about that and it is on boards, but I've never met a patient with it". Which tells me that it is not screened for enough. In retrospect, I believe that my mother probably had undiagnosed B-12 deficiency as well (based on her symptoms) - she died 4 years ago of NHL.
But prior to that she had early onset CAD and needed a CABG - B-12 levels lead to hyperhomocysteinemia which can lead to atherosclerosis, so may have been a contributing factor in my mother's illness. PAS can be associated with some malignancies, so it is a bit disconcerting to know as much as I do (and sometimes know more than the docs treating you!) I'm essentially a walking medical textbook - but have most of the exceptions to the rules.

The night that this happened, I was listening to the radio and I heard a sports reporter say, "We don't really know what happened because the Brushi family has asked doctors at Mass General not to discuss the case." (possibly not a direct quote, but close at least) I remember thinking, "good for them." Then the reporter said tapes of the 911 call indicate blurred vision and sudden onset headache. So all the reporters have to go on when one of Boston's most popular athlete ends up at Mass General is a short phone call from a worried spouse and they took that to their medical "experts" who said the word stroke and that's what they ran with because that's what people have heard of. Now, if that scares a few less than healthy people who ARE having strokes into calling 911 because if it can happen to Tedy Bruschi it can happen to them, that's not an all bad thing.
Not that I'm defending shoddy reporting: when you don't know there's nothing wrong with saying "I don't know." Especially in this case when you have a reason that every reader can relate to: "Mr. Bruschi and his family have chosen not to release his private medical records." Really, would any of us want the details of an ER visit printed in the paper? And on reflection, don't our rich and famous deserve that much privacy at least?

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